In the last few weeks we’ve reached the stage where a number of our clients have cost and income information associated with individual records of patient care.

It’s great to get to that position, as the culmination of the best part of two years work on patient level information and costing systems. It’s been a fascinating journey.

Firstly, because PLICS takes you to the heart of what information in healthcare is about: it allows you to ask questions about cost-effectiveness of care and in such a way as to animate a real debate with clinicians. For example, I find it exciting that the systems we’ve implemented reveal huge variations in cost for essentially the same treatment. This is a great starting point for discussing with clinicians just what works and what doesn’t, what expense needs to be accepted and what expense can be cut.

Secondly, the experience has been a real challenge. Dealing with the finance data, which I expected to be hard, has proved far less difficult than getting the full range of activity data that we need. Finance staff expect systems to be comprehensive: they have to be, because a ledger simply won’t balance if it doesn’t cover the full range of an organisation’s work. Those of us, inside or outside the NHS, who have been dealing with activity data for some years know, however, that such data is always a bit of a work in progress – so much is good, so much is in development, so much hasn’t been attempted yet.

All the different kinds of information are all kept in different systems, too, with no obvious way of bringing them all together.

Overcoming this kind of problem so that we can match all the patient activity data with the corresponding financial figures has been stimulating and made us look at questions which in the past we’ve perhaps not had to tackle head on, such as:

• How do you link Audiology data with data about inpatients or outpatients?
• How do you tie up the costs of Pharmacy with the corresponding patient care events?

None of this has been straightforward. That makes it all the more satisfying when you can look for the first time at patient records with all the different elements of cost (e.g. nursing, surgeon’s time, anaesthetist time, etc.) separately identified on them.

Now the trick is to make sure that our clients are able to use the information to work with clinicians in delivering real improvements in hospital care.